Comparing ran-out status of inhaled short-acting beta-agonists in emergency department patients with acute asthma: 1996-1998 versus 2015-2017

Publication date: Available online 11 April 2018
Source:The Journal of Allergy and Clinical Immunology: In Practice
Author(s): Tadahiro Goto, Carlos A. Camargo, Catalina Gimenez-Zapiola, Daniel J. Pallin, Nathan I. Shapiro, Thomas J. Ferro, Carolyn Rainville, Stanislav Stoyanov, Kohei Hasegawa
BackgroundMedication non-adherence including running out of inhaled asthma medications, is an important problem.ObjectiveTo examine the changes in the proportion of adults with acute asthma who ran out of their short-acting beta-agonist (SABA) inhalers before presenting to the emergency department (ED) between 1996-1998 and 2015-2017.MethodsWe analyzed data from prospective multicenter observational cohort studies of ED adult patients (aged 18-54 years) with acute asthma. Within the same three EDs, we performed a structured interview during two time periods: 1996-1998 and 2015-2017. We fitted multivariable models to compare ran-out status between the two periods, adjusting for the baseline patient demographics, socioeconomic status, chronic asthma factors, and healthcare utilization factors. We further adjusted for the presence of a written action plan – an intervenable factor.ResultsThe analytic cohort comprised 353 patients (150 from the 1996-1998 studies and 203 from the 2015-2017 study). Over the ∼20-year period, the proportion of patients who ran out of SABA inhalers increased (18% in 1996-1998 vs 26% in 2015-2017). In the multivariable model, compared to patients in 1996-1998, those in 2015-2017 had a significantly higher risk of running out of their SABA inhalers (adjusted OR 2.01; 95%CI 1.06-3.81; P=0.03). With further adjustment for the presence of a written action plan, this difference attenuated (adjusted OR 1.66; 95%CI 0.75-3.68; P=0.21).ConclusionBetween 1996 and 2017, the proportion of ED patients with asthma who ran out of SABA inhalers significantly increased. The increase was explained, at least partially, by a lack of written action plan.